Taking the leap to locums
Why should physicians try locum tenens?
There are so many great reasons to try locums, but you won’t know it until you try it and if you do, it will open up your horizons for everything else you do because you'll know all the different opportunities that are out there. Give it a shot. You want to make sure that you get in with a good company. CompHealth has been great for us. You want a rep you can rely on, who you can trust to tell you the truth, and who'll set you up with good situations. I can think of a hundred reasons to do locums and everybody’s got a few that really would meet their needs, but if somebody’s thinking about locums, try it. Find a good company and try it.
What makes a great locum tenens physician?
Well, I think that’s largely about being a good doctor. If you are someone who is knowledgeable and caring and has a good bedside manner, those are all core competencies of a good doctor that translate perfectly into the locum tenens world. But in addition to that, I think you have to be the kind of person who doesn't mind change and is very flexible and is not put off by multiple different electronic medical record systems, because you’re going to be exposed to all kinds of different digital means of keeping records. If that bothers you or learning a new computer system is difficult, then maybe this isn’t the work for you. But if you don't mind and you’ve got an adventurous spirit and a big heart, I think locum tenens is the perfect opportunity to share your skills with a lot of different people across the country.
How does locums make it easier to transition into retirement?
Locums are ideal for people like myself who want to be part-time physicians. The expression of retiring is something that people use and it sounds like retirement is inevitable and you’re just kind of slipping out. I think it’s more than that. It’s a distinct segment of your life when you’re done with being on call. You’re older and less physically resilient and you just can’t take it anymore and you don’t want to take it anymore. You get too tired and you get fed up with that. But there’s a period when you want to do part-time work. You actually want to be working part-time and then getting to enjoy yourself part-time.
How do locum tenens physicians benefit the facilities that hire them?
When I get to an assignment, most people have done without for so long that they are thrilled that somebody walked in the door. It’s like, “Thank God you’re here.” I’ve heard that more than once. Often we’re helping a physician who’s right on the brink of burnout; the staff in that facility has a long-standing relationship usually with this person and they’re starting to feel for this person. This person needs help. This doctor has to have help and they know that somebody like me needs to come in and help them out. When I do, I’ve heard more than once, “Thank you for coming in so that doctor whoever could have time off because we love him and we hate to see him or her go.” It's been both men and women. Then you kind of get to know the people after you’ve worked there a little while, and then they’re glad to see you come back because you make friends and you get friendships.
Can locum tenens be a full-time career?
Initially I started doing locum tenens because I wanted the freedom to work when I wanted to work and not work when I didn’t want to work. I did most of my initial locums work in a very metropolitan area. I then decided that instead of using it as a stopgap I wanted to use it as a career. I have gone back and taken a couple of perm jobs which didn’t really fit me very well, and I have now come to the decision that locums is where I want to be. When opportunities come up for a cruise or a trip abroad or there’s a family event, I can change my schedule and accommodate it. I can take ten weeks of vacation in a year if I choose to or I can work a lot if I choose to.
Can locum tenens lead to a permanent position?
When I was at my last permanent position we had hired some of our locums physicians. It was sort of a “try before you buy,” and two of our physicians had been locums beforehand and interacted so well with the staff, made such good friends, were such a good fit, that we offered them permanent jobs and we were just delighted when they decided to join us. It’s just nice to be able to work in a situation for a while when you don’t have a commitment to see if it’s a good fit. That’s more comfortable than the old-school practice of going out for interviews and then signing a contract when you don’t really know how the situation's going to work out. I really think the locums audition works better that way and leads to greater job satisfaction.
What advice would you give new physicians?
I think I would tell doctors to start with the locums experience very early in their careers because you don’t know how its going to fit into your life and you’ll get a sense of what it is. It may fit into your life years down the line. You might start off doing locums full time from the get-go. Or after a couple years of being in a group that you don’t like, you want to leave that group then that might be the choice for you. If you don’t have that experience early you’re really never going to know, because life takes over and your family takes over and then your kids take over. It becomes less and less of a possibility in your head. So if you have the experience then you will always have it as a possibility.
How can locum tenens help physicians who are starting a practice?
Doing locum tenens work allows me to work around my somewhat inflexible schedule in setting up my practice. From a financial standpoint, locums is an excellent opportunity primarily because of the flexibility. I can arrange my locums assignments around important business meetings and things that I have to be in Cleveland for to be physically present for the build-out of my practice.
Benefits gained from locums.
How does locum tenens help prevent burnout?
Locum tenens--especially CompHealth--came along for me at such a critical time in my career because I had been wondering if I wanted to continue in medicine. It allowed me to continue in medicine in a way that suited my lifestyle at the time and has kept me in medicine and has sort of helped transition me through difficult personal times. I’m very, very grateful. I thought that locum tenens would give me the opportunity to see as many different practice settings as I could without having to commit to any of them on a long-term basis. I was very pleasantly surprised that I could really do that. I only really saw three different practice settings but that was enough for me to help me decide what the next steps of my career route were going to look like. I got to work in a rural setting which was a complete eye opener. I had never done that before, in two rural settings, actually. And to see the need and what was special about those settings and how I had to adapt and be flexible. That was good because those were new muscles that I was getting to use and I think that has helped me in the long run and definitely helped build my confidence that I could go into different settings and help them and do well.
How does locum tenens impact your work/life balance?
Most jobs you can’t just say, “I’m going to take these two months off and then I’ll come back after those two months.” It doesn’t work that way. With locums I can basically schedule in advance and know that I'm going to be moving or traveling or vacationing somewhere for two months or a month out of the year in advance. I would tell myself, “I’ve got to work harder these next couple of weeks.” It really, really works out. I have time to spend with my family, I have time with my girlfriend, and I have time for my hobbies outside of work.
How can locum tenens help you love your job again?
I think the problem, one of the problems in medicine these days, is that the majority of our jobs is no longer on medicine itself. It’s on the extrinsic things; the meetings, the new rules, the administration. And those things add to fatigue. So you have a physician who’s tired before they even start for the day. I think it really does amplify over time. With locum tenens I always joke that I haven’t been to a meeting in over 11 years and I haven’t missed that one bit. I said when I started doing locum tenens, at my previous job but I hated my job. Now I can say I love both.
What clinical skills can you learn by working locums assignments?
I think one of the nicest surprises for me about working locums was the reminder that there is more than one way to do things. When you stay at one place for a long time you get used to doing things one way. You get used to doing things the same way over and over again until it just becomes habit and you don’t realize that you’ve been stuck in a rut. I didn’t know that this was going to be one of the nicest benefits of locums for me: just the reminder when I went to other places that there were other ways of doing things and that people had different practices and that kind of shook me out of my rut. I didn’t even know I was in that rut. Now I don’t always agree with those other ways of doing things and that’s kind of nice too, because if I don’t agree with something then I can go look up the literature, which is also another way of continuing to learn. And if I find that the other way is just as good as the way I was doing it, then I’ve learned something. And if I find that the other way is not as good then I have something to teach and I love teaching. That’s been really nice, learning to look at things from different angles and different perspectives. I didn’t know I was going to get that experience from locums and that actually is the thing that I like most now about doing locums. It’s the reason why even though I’ve accepted a permanent position elsewhere I continue to do locums because I still like that experience.
How has locum tenens improved time with your family?
I have had full-time jobs over the years. One was a very intense university hospital, and at that experience I basically worked all the time. I was at work before the kids woke up. I did not come home until well after a respectable dinner hour. When I was home I would have to sign on to the VPN and finish all my charts and clean up my email, so it really was a miserable experience. I was absent for all of my children’s activities. I never went to school plays or dance recitals. It was really just impossible to juggle that with the workload I had. With locums I leave anywhere from one to four, five, or six weeks at a time, and I dedicate my life 100 percent to my job during the weeks that I’m away from my family. It doesn't matter if I have to work overtime, weekends, evenings. It’s 100 percent full dedication to my job. When I’m home I’m 100 percent a mom. I actually go to my children’s plays and recitals. I may miss a few when I’m away but at least I get to see the ones when I’m there and I’m at home. I’m at home more than when on assignment, so I actually get to see quite a bit of what my children do and I’m very much involved with their daily lives. I know who their friends are, I know who their teachers are. I didn't know who their friends and teachers were when I worked full-time. I couldn’t, it was impossible.
Can you take your family on locum tenens assignments?
It’s been a real blessing for me both in terms of the time that I take my family with me on the assignments, that's been great and it feels like a work vacation. You are working, there is no joke about that, but it also has a vacation component. When I do locums I’m able to have big chunks of time off in between. Sometimes I pack it in and then I can have a week or two weeks or longer off, so doing locums has just been the greatest thing for my family and really is one of the biggest parts of why I keep doing locums.
Are locum tenens jobs available in different practice settings?
The very first assignment I had was with a solo practitioner, which is, as we know, the dinosaur of medicine. This was a lovely, one-physician medical oncology practice. He had a very good nurse practitioner and a team of nurses working for him. I was impressed how the staff knew everybody on such a personal level. That is not something you find in a large university practice where secretaries and nurses are pretty much coming and going all the time so you don't have that personalized touch. I’ve also worked in big university hospitals that needed extra help, and big state hospitals; I’ve also worked with government hospitals. Each one has its own way of practicing and there are advantages and disadvantages to every practice type.
How do part-time assignments impact your full-time job?
It’s improved my career options. By having CompHealth as a part of what I do, locum tenens as a part of what I do, I’m able to pursue the career that I really want to pursue and not feel trapped in a position or a place. I’d like to make a career move but it’s scary. When you are working locums and you are working with a good organization like CompHealth that you trust and with whom you have an ongoing relationship, then it allows you to take risks with your primary job to do what you really want to do. I’ve made several career changes in the last seven years that I’ve been with CompHealth. Each one has been such a great change from the last career to this one, and working with CompHealth has given me a better primary career as well.
Answering concerns about locum tenens.
Is locum tenens work less stable than a full-time job?
For those doctors who think that locums is scary because of a perceived lack of permanence, I would say the job you have right now, unless you own your own practice, has a lack of permanence. Once your contract runs out, if the facility you’re working at decides they need to get rid of you, they can give you a contract that you can find unacceptable. In that sense your job really isn’t permanent. Take a weekend or a week assignment. What’s the worst that can happen? You went and did a weekend or a week assignment. If you didn’t like it, you didn’t like it, so what? But if you do like it it’s going to open up the world to you.
Are you able to make meaningful connections with patients during assignments?
Some doctors might be concerned that they wouldn’t be able to have the same kind of long-term or in-depth relationships with patients doing locums, but I think one difference is when you tell people that you are a visiting physician. At least for me I have been able to feel like I can say "I’m here with you now. I’m going to do whatever I can for you now," and I take the time to really bond with that patient as much as possible. I’ve been fortunate because having gone back to the same places patients will ask for me, patients will wait to be scheduled with me. I feel like again, the boundaries are much better because when I’m there I’m 100 percent in and when I’m not there I know another physician is taking care of those patients. It has in no way impaired my being able to bond and take care of patients in the way they need. Especially pregnant moms, they sometimes need a lot of hand-holding and I'm happy to do that when I'm there.
How do facilities treat locum tenens?
When you work in a hospital I think the staff gives you what you give them. So if you portray a very positive attitude and you are flexible then I think it’s going to come back to you. I’ve always been treated very well. It takes a certain knack to be able to navigate the world of various work environments, working in various different ERs. But I think that they very quickly see that you want to be there and so they like you because of that.
Is it intimidating to try locum tenens right out of residency?
I was a little afraid that once I was out being a real doctor and attending physician that I was not going to be ready. Then I thought about it and said, “I’m not going to sign up for a two-year contract right from the start if I’m not going to be ready. What if I don’t like the place? I’m kind of stuck in a rut that way and I can’t just leave." Locum tenens felt like the most natural thing for me to do. So I remember prior to my first assignment I was reading up on things, reviewing things, watching videos, thinking of scenarios like when a patient would come in and I was the only provider, and what I would do. Then when I started my first assignment it turned out to be pretty straightforward. It was just like my normal day clinic that I was doing for the last three years in residency but this time I had the added bonus of being my own boss finally. I got to make my own decisions. A lot is to be said for autonomy when it comes to becoming a physician. When I was a resident I loved having someone watch over me and say, “Hey, this is not right. Do it this way.” But when I became an attending physician on my own I really, really enjoyed the fact that I was doing this for myself, and I was working directly with a patient without having someone else make the decisions for me.
How does your recruiter help you prepare for an assignment?
Allowing me to know what I’m going to be doing when I open that door, that first day, is important both for the client and for the physician provider. So the knowledge of what sort of environment, what sort of practice, what’s important to that particular assignment, the easier it is to function efficiently, to give good quality patient care, and to serve the client.
What do you do on assignment when you're not working?
Often people ask me “What do you do when you’re on assignment when you’re not working?” That is one of the more difficult things sometimes is to figure out how to entertain yourself when you’re on assignment. You’re in a hotel room and that’s entertaining for about the first five minutes and not much afterwards. But every place has something to offer. I’ve been to Alaska and of course there’s no end to what you can do in Alaska if you like to be outside, it doesn’t matter what time of year. Every place has something to offer, so I tell people to look it up online and find out things that are available in the area. And I find when I go someplace that I’ve seen more of that area than most people who have lived there their entire lives.
Is it intimidating to start a new assignment?
The first time there’s a bit of a feeling like anything could happen, but after you get used to going to a hospital on a locums assignment you start to realize that CompHealth has painted a very accurate picture of what it’s going to be like. There’s usually someone there to meet you and who will give you an orientation, a physician who’s happy to give you patients and meet you as well. I’ve had great experiences going into hospitals, and at this point I feel like I could go to any hospital and quickly fit in and take care of patients. But at first it is a little bit daunting, with a new system and going to a hospital for the first time.
Dealing with the logistics.
How do you decide which assignments to take?
Throughout my time in locum tenens, I’ve worked at all kinds of hospitals. I’ve worked in assignments where I was the only anesthesiologist in town. And I’ve worked at a large tertiary referral center where I was one of probably 40 anesthesiologists. So I’m comfortable with all sizes of hospitals and clinics and I’m comfortable with any number of anesthesiologists. I like to look in an area that has opportunities to be outside. As much as I like to be inside reading and so forth I like to be outside. So Alaska was definitely an intriguing opportunity for me. I listen to what the recruiter has to say about the job. There are certain things you listen to, you want to hear that they’ve worked with this client before, that they know something about them and that we’re not flying blind into a new area. But I’m generally open to most opportunities. Especially when it’s from a recruiter I already know and trust.
What are the benefits of having multiple state licenses?
I have acquired ten different licenses over my locums career. One of them I’ve never used because a job fell through, but the other nine are all in areas that I like to go to. I’ve gone to the Tidewater of Virginia and seen some of the Civil War sites between calls. I’m an avid embroiderer and I’ve found embroidery shops out there. I’ve been there when the wisteria is blooming. I’ve been there when the cherry blossoms were blooming. I’m basically a Midwest girl, so my licenses in Wisconsin, Iowa, Minnesota, North Dakota, Nebraska, and Kansas represent kind of the home territory. My husband travels with me most of the time. We go to different areas and get to see local things. We’re really both pretty interested in museums and history so we get to go and see little local museums and read all the roadside historical markers and get a feel for the area. Having that freedom to go to all those places is good.
Is it tough to arrange travel for locums assignments?
I have a wonderful travel person who arranges everything for me. Without Kathy, I probably wouldn’t be doing as much traveling as I do. She can arrange for me to leave home and get to my assignment, then she can arrange for me to leave my assignment, go to a vacation spot, and eventually get home. That ends up helping me to maximize my time off. It also gives me the nice benefit that the locums job will pay me to get from home to the job and from the job to the vacation, and then I only have to cover getting home from the vacation. I’ve got a couple more of those planned this year where it’s going to piggyback and she just gets everything done perfectly. She’s an absolute dream.
How do you manage your taxes as an independent contractor?
As an independent contractor I have to facilitate all of my own benefits and all of my own tax reporting, and I've done that by finding a CPA who only takes care of doctors and she does all fifty states worth of taxes. I also have a financial person who does my 401(k), my SEP, and a couple of other acronyms I don’t get involved in and she calls me up and says, “Can I do this, can I do this, can I do this?” And I say, “Yeah, sure.” You have to have people you can trust to do that.
What types of housing accommodations are available to locum tenens?
I think it depends on where you are, what’s available, and how long you are staying. I’ve been on assignments for longer stretches where I actually rent from the owner where there might be a one-bedroom or two-bedroom apartment you can rent from an individual in the town you are moving to and the agency picks up the fee for that. Those are really comfortable because they come with their own kitchen suites most of the time and multiple bathrooms and whatnot. Hotels are convenient depending on the hotel. Some hotels are more set up for a residence-type scenario. I prefer those because then you get a microwave and a fridge and if you are interested in cooking for yourself after hours it makes it a lot easier. Really the sky's the limit; anything from staying with a relative to staying at a rent-by-owner scenario or a hotel that is focused on a more long-term stay. All of them I have done and they’ve worked out very nicely.
How does CompHealth help with the physician credentialing process?
The longer one has been in practice or doing their job as a physician, the harder it is to keep one's credentialing in order. Every work opportunity that you do, every job that you accept, every hospital that you’ve ever been assigned to, they have to credential you. Having to keep up one's credentialing with insurance companies, having to qualify and re-qualify, submit all of your education credits, to every different entity that is involved makes it time consuming and daunting, and very rapidly becomes something about which physicians say, “I’ll do that tomorrow.” They put it on the backburner. Credentialing is something that CompHealth has picked up the ball for me and has taken care of just about all of the little incidental things that to me are nuisances but are important. The accuracy of the details is something CompHealth’s support staff has shown that they handle very well.
How does your recruiter find the right housing for you?
I appreciate the value and the reality of what it feels like to be home. Those assignments where I’ve had the opportunity to be in a furnished private home have included Internet access, a WiFi hookup and some cable TV to watch the news. Those are things Kathy knows are important to me. There might be other things that are important for other physicians. I am certainly not a runner or a jogger or a mountain bike guy but I know that if those things were important, Kathy would have looked into that or the people who are setting up the particular housing environment that I’m going to be in. They know what my avocation is, what my extracurricular activities would be. They do try to find housing that fits into my lifestyle or fits into a locum tenens lifestyle.
A few extra tips.
What do you look for when choosing a staffing agency?
When I call somebody I want to see if they actually are listening to me and if they’ve actually even looked at the information I’ve sent them. I’ve had staffing agencies that will call me about a job in a state in which I’ve never been licensed. I’ve had agencies that have called me thinking that I was a CRNA not an anesthesiologist and I was like “It’s on my CV.” So I look for an agency that actually listens. Not only listens to what I’m saying on the phone but about what I like and don’t like, where I like to work and don’t like to work. I like an agency that I feel like is going to be there for me when things don’t go well. 95% of the time things do, but I want someone there for me for the 5% that it doesn’t.
What should residents or fellows know about locum tenens?
You don’t really get trained on how to look for jobs in residency. The focus is on the clinical skills. You don’t really get to learn how to manage a practice. The business of medicine is very key and we don’t learn that. Even if you are trying to find a permanent position you could definitely do locums. There are a lot of physicians who end up in permanent positions when they start locums. It kind of gets them into the whole industry because they get to try different things out. You get to travel and they pay for most of your travel expenses and lodging and things like that. It’s great if you want a flexible schedule. Once I tell that to my colleagues, they get a little excited for me. I would say some are even a little jealous. They’ll say, “I see you are off. Do you ever work?” They see me all the time relaxing. I’ll say, “Of course I work. I work as hard as you if I want to.” That’s the difference. I’m not stuck in a place. I can get up. I can really make my own schedule and I think that’s key. You can’t really put a price on that.
How does working locum tenens allow you to give back to the community?
Because of locums I’m able to do volunteer work. I have colleagues who want to do volunteer work but they literally don’t have the time. They work every day. They may be off on the weekends but they’re often on call. They have families and it’s really very difficult to put in several hours of volunteer work. I feel because I work a week and I’m off a week, that’s the perfect time for me to get into some of those volunteer activities that I would I love to do. In the past I’ve also done volunteer clinics. After Hurricane Katrina, I worked at a volunteer clinic for two weeks and that was an amazing experience. First of all, there was such devastation around and the people were so truly thankful. They really were. It’s amazing how people can come together in catastrophes.
How would you describe your relationship with your recruiter?
I had a brief interaction with other large recruiters, but it was CompHealth that rose to the top. They demonstrated their core values and a dedication that was very obvious from the first interaction with my recruiter, Kathy. She didn’t know me, I didn’t know her, and despite that we got to know each other very well and have subsequently gone on to be very good friends. I look at her--yes, she’s the person who is helping me with my job, my employment, my vocation--but we share so much together that it has become a friendship. I care about her, I care about what happens to her and her family, and I’m sure she’s the same with me.
What do you like about working with your recruiter?
Sarah has really been the quarterback in my arrangements between CompHealth and the facilities I work for. Things have always run very smoothly. Now it may not be Sarah who takes care of the actual issue, oftentimes there are other people involved behind the scenes and others directly. Usually issues are resolved with ease. If I have a problem, I know I can call Sarah and the issue is resolved whether it’s her who takes care of it or not.
Why do you choose to work with CompHealth?
I chose CompHealth because of that first interaction with Jen Bambrough, and really it set itself apart from my interaction with other recruiters. It set itself apart because of the human element. She was a person talking to me as a person, trying to find out what I envisioned locum tenens to be and matching me with other clients who would work well with me and that was it. And I’ve never needed to go anywhere else.
Who helps coordinate your locum tenens assignments?
Working with Sarah Thacker at CompHealth has been a wonderful experience for me because she’s made everything very smooth. She’s the main point of contact I have and I know she has a big team of people working behind her to make sure that everything goes smoothly from housing situations to payroll. Whenever I have a question, a need, or concern, I know that my point of contact is Sarah. Also she knows what my desires are, what my preferences are, what I look for in a location, and having one person working for me for an extended period of time has been fantastic, and I can’t imagine it any other way. You come to count on that person and what they tell you as the truth and what you need to know when going somewhere.